Healthcare Provider Details

I. General information

NPI: 1932724390
Provider Name (Legal Business Name): FRIEND FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 S JEFFERY BLVD
CHICAGO IL
60649-3121
US

IV. Provider business mailing address

PO BOX 19351
CHICAGO IL
60619-0266
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-0660
  • Fax: 773-834-3756
Mailing address:
  • Phone: 773-702-0660
  • Fax: 773-834-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SABRINA G MOORE
Title or Position: CFO
Credential:
Phone: 773-702-2193